Professional Documents
Culture Documents
Carestream Dental LLC
3625 Cumberland Blvd. Ste. 700
Atlanta, GA 30339
US
Carestream Dental LLC('Carestream Dental LLC','we','us','our'), a limited liability company with principal offices located at
the above address presents this proposal to the customer identified below ('Customer','you','your'). This document
incorporates by reference the attached terms and conditions and detail order information and shall be a binding sales
agreement (the 'Contract') when signed by you without alteration, and shall be effective as of the date you signed
('Effective Date'). If not signed by the 'Valid until' date indicated below, this proposal shall expire.
Product Code Line Item Description List Price Sales Price Quantity Total Price
1759109 SENSEI CLOUD DENTAL - YELLOW BELT USD 1,000.00 USD 1,000.00 1.00 USD 1,000.00
*Applicable taxes will be added and are subject to change. Organizations claiming tax-exempt status must provide proof of that status on or
prior to the Effective Date.
Product Notes
Product
Maintenance
Items in the section below may carry additional monthly maintenance fees as indicated.
Monthly Maintenance
Product Code Line Item Description Monthly Maint Price frm Quantity Total Maintenance
1759109 SENSEI CLOUD DENTAL - YELLOW BELT USD 350.00 1.00 USD 350.00
Maintenance Totals
ACH Debit
Authorized
Bank details on file Bank details not on file
A voided check must be presented to us when using an ACH payment. Your signature authorizes the Company to verify your checking account
information and begin ACH debit transactions against your checking account. To terminate an ACH authorization, you must give us notice, and
we will cease ACH withdrawals within seven (7) days of receipt of that notice.
Credit Card
Authorized
Credit Card Details No card on file
New Card
Your signature authorizes the Company to begin debiting transactions against your credit card provided. To terminate a credit card
authorization, you must give us written notice, and we will cease credit card withdrawals within seven (7) days of receipt of that notice.
YOU WILL PAY THE FEES DESCRIBED ABOVE FOR THE PRODUCTS SET FORTH IN THIS CONTRACT, AND YOUR ACH OR
CREDIT CARD LISTED ABOVE MAY BE CHARGED THE BALANCE OF THE PURCHASE PRICE FOR THE PRODUCTS
DESCRIBED ABOVE, AS WELL AS FOR APPLICABLE SALES TAX AND SHIPPING, LESS THE DEPOSIT, WHEN THE ORDER IS
SHIPPED, UNLESS OTHERWISE SET FORTH IN SECTION 2 OF THE TERMS AND CONDITIONS OF THIS CONTRACT.
YOUR ACH OR CREDIT CARD LISTED ABOVE MAY BE DEBITED MONTHLY FOR MONTHLY SUPPORT & MAINTENANCE FEES
(IF ANY) AND/OR SUBSCRIPTION FEES (IF ANY) SET FORTH ABOVE.
YOU ACCEPT THE TERMS AND CONDITIONS OF THIS CONTRACT.
YOU ARE A DULY AUTHORIZED REPRESENTATIVE OF THE CUSTOMER.
Print Name:_______________________________________________________